Preventing stent failure using adaptive shear responsive endovascular implant

ABSTRACT

A stent apparatus, system, and method that senses wall shear stress by measuring fluid flow at localized areas within the stent, that processes measured information through an integrated circuit, and selectively sends power to mechanically controllable stent surfaces which results in localized geometric changes. In various embodiments the stent apparatus, system, and method sends data to outside the body in real time.

STATEMENT AS TO RIGHTS TO APPLICATIONS MADE UNDER FEDERALLY SPONSORED RESEARCH AND DEVELOPMENT

The United States Government has rights in this application pursuant to Contract No. DE-AC52-07NA27344 between the United States Department of Energy and Lawrence Livermore National Security, LLC for the operation of Lawrence Livermore National Laboratory.

BACKGROUND Field of Endeavor

The present application relates to stents and more particularly to apparatus, systems, and methods for preventing stent failure using an adaptive shear responsive endovascular implant.

State of Technology

This section provides background information related to the present disclosure which is not necessarily prior art.

When an artery lumen is partially or completely blocked and causes symptoms or ischemia, an intervention is required to open the blocked vessel and restore blood flow to the organ. This procedure is accomplished using a balloon to widen the vessel lumen that allows a stent to be implanted and function as a scaffold. Traditional metal stents are hollow, slotted, tubes with different stent strut thickness and cell shape. These stents can be coated with a polymer (biodegradable vs. permanent) and loaded with an antiproliferative-limus drug (e.g., everolimus, zotarolimus) that is eluted to prevent vascular smooth muscle cell proliferation. A second type of stent, the biodegradable vascular scaffold (BVS), uses poly-L-lactic acid as its backbone instead of metal. This stent has less rigidity than a traditional metal stent, can elute drug, and dismantles over 3-5 years leaving the artery “stent-free.”

While stents are effective as vascular scaffolds to prevent abrupt closure, they are subject to failure. This may occur as a result of neointimal formation or neoatherosclerosis, which occurs in 15-30% of drug-eluting and bare metal stents, respectively. Stents are also subject to stent thrombosis, or occlusion of the stent with thrombus, which occurs at 1% in first 30 days after implantation and at a rate of 0.4-0.6%/year thereafter. In both cases of stent failure, patients may experience angina, myocardial infarction or death as the first symptom and there is a significant increase in healthcare costs associated with stent failure.

U.S. Pat. No. 9,662,021 for miniature stent-based implantable wireless monitoring devices issued May 30, 2017 provides the State of Technology information quoted and reproduced below.

“Stents have a variety of applications and are most widely used in treating obstruction of blood flow in the cardiovascular system. A common problem with stents is reocclusion, although current technologies employed to alleviate this problem include the incorporation of drug-eluting coatings as well as using careful consideration when choosing base materials. Even with these preventative measures, re-occlusion can still occur without warning since little is known about the performance of stents after initial placement.” “A device that monitors pressure in the surrounding area, as well as blood flow and temperature, would provide clinicians with a method for monitoring PADP, and therefore PCWP, and would provide information regarding how well the stent is faring in the implanted environment. Fully wireless operation as well as integration with the stent is crucial for such a device monitoring device. Current wireless cardiac pressure sensor devices require either a clinical visit or manual interrogation of the device using an external transmitter and receiver. This limits the overall effectiveness of the system by relying on the patient or a clinician to initiate collection of diagnostic data.” “What is needed therefore is a completely wireless implantable system implanted in the pulmonary artery and having fully wireless capability, in terms of both telemetry and powering, through the chest wall to record cardiac diagnostics at fixed intervals without manual intervention.”

SUMMARY

Features and advantages of the disclosed apparatus, systems, and methods will become apparent from the following description. Applicant is providing this description, which includes drawings and examples of specific embodiments, to give a broad representation of the apparatus, systems, and methods. Various changes and modifications within the spirit and scope of the application will become apparent to those skilled in the art from this description and by practice of the apparatus, systems, and methods. The scope of the apparatus, systems, and methods is not intended to be limited to the particular forms disclosed and the application covers all modifications, equivalents, and alternatives falling within the spirit and scope of the apparatus, systems, and methods as defined by the claims.

Applicants' apparatus, systems, and methods incorporate an adaptive design with a shear responsive sensor to mitigate the occurrence of stent failure. Applicants' apparatus, systems, and methods redesign the common stent into a novel active, smart device, which can severely attenuate or even prevent plaque material from adhering to the lumen of the stent. This is accomplished through a distributed network of flow sensors and addressable mechanical stent surface modification regions. These are connected to a custom integrated circuit processor that can analyze the flow data and determine small changes in the stent surface to eliminate low wall shear stress areas. Eliminating low wall shear stress areas prevents plaque from adhering to solid surfaces and will inhibit restenosis from occurring.

Applicants' apparatus, systems, and methods function by sensing the wall shear stress by measuring fluid flow at localized areas at the luminal surface of the stent, processing information through an integrated circuit (comparing the data to model simulations of flow perturbation), and selectively sending power to the mechanically controllable surface which results in localized geometric changes.

The apparatus, systems, and methods are susceptible to modifications and alternative forms. Specific embodiments are shown by way of example. It is to be understood that the apparatus, systems, and methods are not limited to the particular forms disclosed. The apparatus, systems, and methods cover all modifications, equivalents, and alternatives falling within the spirit and scope of the application as defined by the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated into and constitute a part of the specification, illustrate specific embodiments of the apparatus, systems, and methods and, together with the general description given above, and the detailed description of the specific embodiments, serve to explain the principles of the apparatus, systems, and methods.

FIG. 1 illustrates one embodiment of Applicants' apparatus, systems, and methods.

FIGS. 2A, 2B, and 2C are illustrative views of Applicants' apparatus, systems, and methods.

FIGS. 3A, 3B, and 3C are illustrative sectional views of Applicants' apparatus, systems, and methods.

FIGS. 4A and 4B illustrate embodiments of additive manufacturing systems for making the smart stent.

FIG. 5 is an illustrative view showing another embodiment of Applicants' apparatus, systems, and methods.

DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS

Referring to the drawings, to the following detailed description, and to incorporated materials, detailed information about the apparatus, systems, and methods is provided including the description of specific embodiments. The detailed description serves to explain the principles of the apparatus, systems, and methods. The apparatus, systems, and methods are susceptible to modifications and alternative forms. The application is not limited to the particular forms disclosed. The application covers all modifications, equivalents, and alternatives falling within the spirit and scope of the apparatus, systems, and methods as defined by the claims.

Referring to FIG. 1, an illustrative view shows an embodiment of Applicants' apparatus, systems, and methods. This embodiment is identified generally by the reference numeral 100. FIG. 1 is an illustrative side view Applicants' smart stent 100. The components of Applicants' smart stent apparatus, systems, and methods 100 in FIG. 1 are listed below.

-   -   100—Adaptive Shear Responsive Endovascular Implant (smart         stent),     -   102 a, 102 b, 102 c, and 102 d-Devices incorporate into the         smart stent 100 during AM manufacturing,     -   104—Stent lattice, and     -   106—Control System (Brain).

FIG. 5 is an illustrative view showing another embodiment of Applicants' apparatus, systems, and methods.

The description of the structural components of the Applicants' smart stent 100 having been completed, the operation and additional description of the Applicants smart stent will now be considered in greater detail.

The stent lattice 104 is a Shape Memory (SM) material that has basic configurations original (shape “A”) and temporary (shape “B”). Changing the temperature of the stent lattice Shape Memory (SM) material 104 in conjunction with an added mechanical force changes the stent lattice 104 from original shape A to temporary shape B. Changing the temperature of the stent lattice Shape Memory (SM) material 104 also changes the stent lattice 104 from temporary shape B back to original shape A.

The devices 102 a, 102 b, 102 c, and 102 d are incorporate into the smart stent 100 during AM manufacturing. For example, the devices 102 a, 102 b, 102 c, and 102 d can be directly built in the stent lattice 104 by projection micro-stereolithography AM manufacturing or the micro-stereolithography AM manufacturing can produce pockets and the devices 102 a, 102 b, 102 c, and 102 d inserted in the pockets as part of the AM manufacturing process. Alternatively, the devices 102 a, 102 b, 102 c, and 102 d can be built in the stent lattice 104 by direct ink AM manufacturing. The devices 102 a, 102 b, 102 c, and 102 d can be Micro-Electro-Mechanical Systems (MEMS) that provide power and flow sensing. For example, in one embodiment the devices 102 a and 102 c provide flow sensing and the devices 102 b and 102 d are heaters that produce heat for changing the stent lattice Shape Memory (SM) material 104 from temporary shape B to original shape A.

The SMP stent structure is printed in original shape A. This shape has the super lattice structure and structural pillar areas that extend into the lumen of the stent (e.g. 102 b,d). The inventors add heat to the entire 104 device along with a force to modify structural pillar areas of the lattice structure (temporary shape B—once the temperature is dropped). Under these structural pillar areas are the heaters (e.g. devices 102 b,d). When individually triggered, the heat under a single structural pillar areas will cause that structural pillar area to expand locally toward the original shape A. Various embodiments will have 10's to hundreds of these structural pillar areas throughout the smart stent 100.

The Control System or Brain 106 is a printed circuit control system that receives information from the devices 102 a, 102 b, 102 c, and 102 d and analyzes the information. If a shear stress threshold is met, computational fluid simulations determine the location and magnitude of stent actuation to decrease the area of low shear stress. In one embodiment the Control System 106 is a microchip.

Applicants smart stent 100 will mitigate the occurrence of stent failure. In various embodiments Applicants' smart stent 100 can be broken down into five subunits: (1) mechanical surface, (2) processing unit, (3) power, (4) flow sensing units, and (5) telemetry. Applicants' smart stent 100 function by sensing the wall shear stress by measuring fluid flow at localized areas at the luminal surface of the stent, processing information through an integrated circuit (comparing the data to model simulations of flow perturbation), and selectively sending power to the mechanically controllable surface which results in localized geometric changes. These conformational changes will perturb the flow within the stent in result in minimizing the low wall shear stress areas. The processing unit, power and telemetry can be integrated into an ASIC chip with the necessary geometrical constraints (3 mm×3 mm×0.3 mm) for in order to use. The mechanical surface will be designed to allow for digitally addressing small pixels to allow for localized changes.

Batteries, sensors, electronic and electrode have all been implanted into humans (e.g. pace maker, deep brain stimulation, insulin pumps). The mechanical surface (the architecture of the stent structure) is a shape memory material (polymer or metal alloy), which can modify its shape on demand. Biocompatible polymers have never been used for fabricating stent structures.

SMP have basic configurations: permanent and temporary. The permanent configuration is the shape at the time of fabrication (shape “A”). Raising the temperature of the SMP above the glass transition temperature (“critical temperature”, Tc), applying a mechanical load, and lowering the temperature locks the SMP into a temporary configuration (shape “B”). Reconfiguring the material from shape “B” to shape “A” requires that the material be heated near or above the critical temperature. Typically, the material is a whole structure process (ie. The entire structure is heated and the whole structure transitions back to shape “A”). If one would think of a sheet of shape memory polymer (SMP) “paper” with text, Applicants' system could locally change the shape under the dot of an “i” or an “o” (and not the entire structure). Thus, by providing local changes there is sufficient resolution for manipulating blood flow within the stent.

Geometrical and power requirement set strict upper bounds on the limitations of Applicants' flow sensor. A MEMS based hot film/wire anemometer (1 mm×1 mm×0.2 mm) will address both of these requirements. An anemometer comprises 2 heater elements (1 to inject energy into the system and 1 to measure that energy downstream). By precisely controlling the amount of energy added to the system and the distance between the elements, one can calculate the velocity by measuring the delta time between injection and sensing of that energy. Controlling the sensor distance from the arterial wall (r), one can calculate the wall shear (dV/dr).

In various embodiments, Applicants' smart stent identifies and attenuates regions of low shear stress in the lumen of a stent through an integrated, distributed network of flow sensors; a custom signal processing unit; and a power supply that selectively sends power to a mechanically controllable stent matrix which results in localized geometric changes. The distributed network of flow sensors maps the hemodynamic flow with the stent. This data is sent to the processing unit and analyzed. If a shear stress threshold is met, computational fluid simulations determine the location and magnitude of stent actuation to decrease the area of low shear stress. The stent device operates as an autonomous closed loop system. The incorporation of telemetry allows for periodic or on demand data reports of stent health, flow data, and actuation and issues logs.

Atherosclerotic coronary heart disease is the leading cause of morbidity and mortality in the United States and is responsible for >1 million myocardial infarctions and coronary heart disease-related deaths annually. Current clinical practice is based on treating established atherosclerotic disease since there is a knowledge gap in methodology to predict where coronary atherosclerotic plaques will develop and no mechanism to intervene and alter the natural biology of the disease. To address this, Applicants have taken a revolutionary approach to prevent atherosclerosis in coronary arteries by implanting a shape-morphing stent with a shear stress sensor in atheroprone areas of the coronary tree. This endovascular implant reports coronary shear stress and actuate (change shape) in response. The endovascular implant report is in real time.

Applicants' apparatus, systems, and methods are designed to function as a dynamically modifiable endovascular stent or scaffold that can be implanted into any vascular bed >1 mm in diameter, other extra-vascular sites where stents have been used for off-label indications, and can be scaled to the largest vessels in the body. Applicants' apparatus, systems, and methods can also be adapted to serve as the scaffold for a heart valve such as that used in surgical or percutaneous valve replacement in the aortic, mitral, tricuspid, or pulmonary positions. Applicants' apparatus, systems, and methods is made of a non-thrombotic biocompatible material that can be adapted to elute antiproliferative drugs and has a sensor that measures hemodynamic parameters (e.g., flow, wall shear stress), reports these parameters to an external monitor, and then based on this data, can actuate a shape change in the stent/scaffold. The sensor can be adapted to monitor other physical, cellular, biological, or molecular factors in the bloodstream such as glucose, potassium, or temperature.

As a therapeutic device, Applicants' apparatus, systems, and methods is used in conjunction with current percutaneous interventional techniques to treat symptomatic atherosclerotic vascular disease in the coronary arteries, cerebral vasculature, and peripheral vasculature. Applicants' apparatus, systems, and methods invention can also be used to treat vascular aneurysms, coarctation, or other vascular narrowings. Applicants' apparatus, systems, and methods can also be used in the pulmonary vasculature in pulmonary arterial hypertension, combined post- and pre-capillary pulmonary hypertension, chronic thromboembolic pulmonary hypertension as well as in the systemic and pulmonary venous and lymphatic systems. Applicants' apparatus, systems, and methods can also be used in any other area where a stent has been used, such as the heart or extra-vascular spaces, such as the airways.

Applicants' apparatus, systems, and methods can also be used as a preventative device by endovascular implantation in the arterial, venous, or lymphatic system to prevent the development of vascular diseases that narrow or increase the vessel lumen and wall such as atherosclerosis, aneurysm formation, or vessel/lymphatic narrowing.

Referring to FIGS. 2A, 2B and 2C; illustrative side views show Applicants' smart stent 100 as it would operate in a coronary artery. The components of Applicants' smart stent 100 shown in FIGS. 2A, 2B and 2C are listed below.

-   -   200 a-Initial view of smart stent in an artery,     -   200 b-View of smart stent detecting turbulent flow in artery,     -   200 c-View of smart stent with corrected stent shape,     -   202 a-Flow sensors,     -   202 b-Heaters,     -   204—Stent body,     -   206—Control system (Brain),     -   208—Flow direction,     -   210—Normal flow, and     -   212—Turbulent flow area.

The identification and description of the structural components of the Applicants' smart stent having been completed, the operation and additional description of the Applicants smart stent will now be considered in greater detail.

FIG. 2A is an illustrative side view of Applicants' smart stent as it would function in an artery. This view is designated generally by the reference numeral 200 a. The arrows 208 indicate flow direction. FIG. 2A shows normal flow 210 that is sensed by flow sensors 202 a. The heaters 202 b and the control system (brain) 206 are part of the smart stent.

FIG. 2B is an illustrative side view of Applicants' smart stent wherein the smart stent has detected turbulent flow 212. This view is designated generally by the reverence numeral 200 b. The turbulent flow 212 can be created by the start of plaque buildup in the stent, by undesirable shape changes in the stent body 204, or by other conditions. In this view 200 b the smart stent flow sensors 202 a signal to the control system 206 allows the control system 206 to detect the turbulent flow 212. If the conditions that created the turbulent flow 212 continued it could lead to failure of the stent; however, with Applicants' smart stent apparatus, systems, and methods the turbulent flow is detected and stent body 204 adjusted to eliminate the turbulent flow 212. The control system (brain) 206 of Applicants' smart stent retrieves data from the flow sensors 202 a, compares the data to model simulations of flow perturbation, and selectively sends signals to the heaters 202 b to activate the heaters 202 b. Heat produced by the heaters 202 b adjusts the mechanically controllable sections of the stent body 204 resulting in localized geometric changes that eliminates the turbulent flow 212.

The stent body 204 lattice is made of a Shape Memory (SM) material that has basic configurations original (shape “A”) and temporary (shape “B”). Changing the temperature of the stent lattice Shape Memory (SM) material provides an added mechanical force changing the stent lattice from original shape A to temporary shape B. Changing the temperature of the stent lattice Shape Memory (SM) material also changes the stent lattice from temporary shape B back to original shape A.

FIG. 2C is an illustrative side view of Applicants' smart stent after it has been adjusted to eliminate the turbulent flow 212. This view is designated generally by the reference numeral 200 c. FIG. 2C shows normal flow 210 has returned.

Referring to FIGS. 3A, 3B and 3C; additional illustrative views show a section (in the middle) of Applicants' smart stent illustrated in FIGS. 2A, 28 and 2C with the sections laid flat. The components of Applicants' smart stent shown in FIGS. 3A, 3B and 3C are listed below.

-   -   300 a-Initial view of smart stent showing normal flow,     -   300 b-View of smart stent detecting turbulent flow,     -   300 c-View of smart stent with corrected stent shape,     -   302 a-Flow sensors,     -   302 b-Heaters,     -   304—Stent body,     -   308—Flow direction,     -   310—Normal flow,     -   312—Turbulent flow area, and     -   314—Pillars (the pillars represent changes in the physical         structure).

The identification and description of the structural components of the Applicants' smart stent having been completed, the operation and additional description of the Applicants smart stent will now be considered in greater detail.

FIG. 3A shows a section (from the middle) of Applicants' smart stent illustrated in FIG. 2A with the section laid flat. This view is designated generally by the reference numeral 300 a. The arrows 308 indicate flow direction. FIG. 3A shows normal flow 310 that is sensed by flow sensors 302 a. The heaters 302 b and the control system (brain) 306 are part of the smart stent.

FIG. 3B shows a section (from the middle) of Applicants' smart stent illustrated in FIG. 2B with the section laid flat. This view is designated generally by the reverence numeral 300 b. The turbulent flow 312 can be created by the start of plaque buildup in the stent, by undesirable shape changes in the stent body 304, or by other conditions. In this view 300 b the smart stent flow sensors 302 a signal to the control system 306 allows the control system 306 to detect the turbulent flow 312. If the conditions that created the turbulent flow 312 continued it could lead to failure of the stent; however, with Applicants' smart stent apparatus, systems, and methods the turbulent flow is detected and stent body 304 adjusted to eliminate the turbulent flow 312. The control system (brain) 306 of Applicants' smart stent retrieves data from the flow sensors 302 a, compares the data to model simulations of flow perturbation, and selectively sends signals to the heaters 302 b to activate the heaters 302 b. Heat produced by the heaters 302 b adjusts the mechanically controllable sections of the stent body 304 resulting in localized geometric changes that eliminates the turbulent flow 312.

FIG. 3C shows a section (from the middle) of Applicants' smart stent illustrated in FIG. 2C with the section laid flat. This view is designated generally by the reference numeral 300 c. The Pillars 314 are stylized illustrations that represent changes in the physical structure of the stent body 304 web. FIG. 3C shows that normal flow 310 has returned.

Referring now to FIG. 4A, a first embodiment of an additive manufacturing system for making the smart stent of FIG. 1 is illustrated. This embodiment of the additive manufacturing system is designated generally by the reference numeral 400 a. This embodiment of the additive manufacturing system 400 a is a projection micro-stereolithography system. One version of the additive manufacturing system 400 a is a Large Area Projection Micro-Stereolithography (LAPuSL) system. The additive manufacturing system 400 a produces the smart stent 100. The structural elements of the additive manufacturing system 400 a are identified and described below.

-   -   Reference numeral 400 a-Additive manufacturing system.     -   Reference numeral 402 a-3-D computer generated model of stent         100.     -   Reference numeral 404 a-CPU.     -   Reference numeral 406 a-SLM system.     -   Reference numeral 408 a-Optics system.     -   Reference numeral 410 a-Beam directing optics.     -   Reference numeral 412 a-Optics system.     -   Reference numeral 414 a-Projected image.     -   Reference numeral 416 a-Reservoir.     -   Reference numeral 418 a-Bath.     -   Reference numeral 420 a-Substrate.     -   Reference numeral 422 a-Elevator system.

The structural elements of the system 400 a having been identified and described, the operation of the system 400 a will now be considered. Initially, a three-dimensional model 402 a of the smart stent 100 is produced in a computer readable format. The model 402 a will be used by the additive manufacturing system 400 a to produce the stent 100. The three-dimensional model 402 a of the stent 100 can be produced by 3-D CAD system.

The three-dimensional model 402 a is sent to the CPU 404 a. The three-dimensional model is digitally sliced into layers by the CPU 404 a. The layers are sent to the SLM system 406 a and subsequently thru 408 a, 410 a, and 412 a to be projected 414 a to their appropriate locations on the moveable substrate 420 a.

The layers are sent from the CPU 404 a to the SLM system 406 a. The layers are sent from the SLM system 406 a to the Optics system 408 a. The layers are sent from the Optics system 408 a to the Beam directing optics 410 a. The layers are sent from the Beam directing optics 410 a to the Optics system 412 a. The Optics system 412 a produces a Projected image 414 a into the Bath 418 a in the Reservoir 416 a. The first layer is produced on the substrate 420 a.

The Projected image 414 a is an image beam that is directed onto the build plane to cure the curable monomer material of the Bath 418 a in the Reservoir 416 a and produce individual layers of the stent 100. The elevator system 422 a sequentially lowers the layers into the curable monomer bath 418 a to allow a fresh layer of curable monomer material to coat the previous layer. The steps for all slices are repeated to complete the stent 100.

Referring now to FIG. 4B, another embodiment of an additive manufacturing system for making the smart stent 100 of FIG. 1 is illustrated. This embodiment of the additive manufacturing system is designated generally by the reference numeral 400 b. The additive manufacturing system 400 b produces the smart stent 100.

The additive manufacturing system 400 b uses state of the art 3-D printing technology to produce the smart stent 100. Initially, a three-dimensional model of the smart stent 100 is produced in a computer readable format. The model is used by the additive manufacturing system 400 b to control the components of the 3-D printing system. The additive manufacturing system 400 b uses two head disposition printing to build the smart stent 100 on a substrate 408 b. The system 400 a uses one head 402 a for producing the web 104 and the other head 404 b for depositing the MEMS 102(a,b,c,d) in the web 104. The computer controller 410 b provides instructions for the 3D printing.

As illustrated in FIG. 4B, one of the print heads 402 b obtains web material from a web material supply source 406 b. The print head 402 b uses the web material to print the web 104. The other of the print head 404 b obtains MEMS devices 102(a,b,c,d) from a supply source 408 b. The print head 404 b deposits the MEMS devices 102(a,b,c,d) in the web 104. The smart stent 100 is printed one layer at a time wherein each layer includes the predetermined portions of the web 104 and the MEMS devices 102(a,b,c,d) as dictated by the three-dimensional model of the smart stent 100. The layers are built on the substrate 408 b.

Referring to FIG. 5; an illustrative view show another embodiment of Applicants' apparatus, systems, and methods. This embodiment is identified generally by the reference numeral 500. The components of Applicants' smart stent apparatus, systems, and methods 500 shown in FIG. 5 are listed below.

-   -   502—telemetry,     -   504—vascular bed, and     -   506—smart stent,     -   508—receiver, and     -   510—signal.

The description of the structural components of the Applicants' smart stent apparatus, systems, and methods 500 having been completed, the operation and additional description of the Applicants smart stent will now be considered in greater detail. The smart stent 506 is shown implanted in a vascular bed 504. The smart stent 506 functions by measuring fluid flow at localized areas within the stent, processing information through an integrated circuit (comparing the data to model simulations of flow perturbation), and selectively sending power to the mechanically controllable surface which results in localized geometric changes. The smart stent 506 transmits data to the telemetry module 502 that controls the operation of the smart stent 506 and analyzes the data. The telemetry module 502 compares the data to model simulations and selectively sends power to MEMS units that mechanically control the stent web and provide localized geometric changes in the stent web to correct for changes in flow due to plaque buildup. The telemetry module 502 can provide “periodic” or “on demand” reports.

The smart stent 506 identifies and attenuates regions of low shear stress in the lumen of a stented blood vessel through an integrated, distributed network of flow sensors, a custom signal processing unit, power supply and telemetry into the shape memory polymer stent. The distributed network of flow sensors maps the hemodynamic flow with the stent. This data is sent to the processing unit and analyzed. If a shear stress threshold is met, computational fluid simulations determine the location and magnitude of stent actuation to decrease the area of low shear stress. The stent device operates as an autonomous closed loop system. The incorporation of telemetry allows for periodic or on demand data reports of stent health, flow data, and actuation and issues logs.

As a therapeutic device, Applicants' apparatus, systems, and methods is used in conjunction with current percutaneous interventional techniques to treat symptomatic atherosclerotic vascular disease in the coronary arteries, cerebral vasculature, and peripheral vasculature. Applicants' apparatus, systems, and methods invention can also be used to treat vascular aneurysms, coarctation, or other narrowings or dilations. Applicants' apparatus, systems, and methods can also be used in the pulmonary vasculature in pulmonary arterial hypertension, combined post- and pre-capillary pulmonary hypertension, chronic thromboembolic pulmonary hypertension as well as in the pulmonary and systemic venous and lymphatic systems. Applicants' apparatus, systems, and methods can also be used in any other area where a stent has been used, such as the heart or extra-vascular spaces, such as the airways. Applicants' apparatus, systems, and methods can also be used as a preventative device by endovascular implantation in the arterial, venous, or olymphatic system to prevent the development of atherosclerosis, aneurysm formation, or vessel/lymphatic narrowing.

Although the description above contains many details and specifics, these should not be construed as limiting the scope of the application but as merely providing illustrations of some of the presently preferred embodiments of the apparatus, systems, and methods. Other implementations, enhancements and variations can be made based on what is described and illustrated in this patent document. The features of the embodiments described herein may be combined in all possible combinations of methods, apparatus, modules, systems, and computer program products. Certain features that are described in this patent document in the context of separate embodiments can also be implemented in combination in a single embodiment. Conversely, various features that are described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a subcombination or variation of a subcombination. Similarly, while operations are depicted in the drawings in a particular order, this should not be understood as requiring that such operations be performed in the particular order shown or in sequential order, or that all illustrated operations be performed, to achieve desirable results. Moreover, the separation of various system components in the embodiments described above should not be understood as requiring such separation in all embodiments.

Therefore, it will be appreciated that the scope of the present application fully encompasses other embodiments which may become obvious to those skilled in the art. In the claims, reference to an element in the singular is not intended to mean “one and only one” unless explicitly so stated, but rather “one or more.” All structural and functional equivalents to the elements of the above-described preferred embodiment that are known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the present claims. Moreover, it is not necessary for a device to address each and every problem sought to be solved by the present apparatus, systems, and methods, for it to be encompassed by the present claims. Furthermore, no element or component in the present disclosure is intended to be dedicated to the public regardless of whether the element or component is explicitly recited in the claims. No claim element herein is to be construed under the provisions of 35 U.S.C. 112, sixth paragraph, unless the element is expressly recited using the phrase “means for.”

While the apparatus, systems, and methods may be susceptible to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and have been described in detail herein. However, it should be understood that the application is not intended to be limited to the particular forms disclosed. Rather, the application is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the application as defined by the following appended claims. 

The invention claimed is:
 1. A stent, comprising: a stent body comprising a stent lattice made of shape memory material wherein said stent lattice includes mechanical stent surface modification regions, a multiplicity of flow sensors connected to said stent body, a multiplicity of heaters connected directly to said shape memory material of said stent lattice in said mechanical stent surface modification regions, and a control system that is part of said stent body and is operatively connected to said multiplicity of flow sensors and said multiplicity of heaters that controls said heaters to change said shape memory material and said mechanical stent surface modification regions.
 2. The stent of claim 1 wherein said stent lattice made of shape memory material is a lattice stent body of shape memory material that has an original shape and different temporary shape wherein heat causes said shape memory material to change from said original shape to said different temporary shape.
 3. The stent of claim 1 wherein said stent lattice made of shape memory material includes a multiplicity of individual mechanically controllable sections of the lattice and wherein at least some of said multiplicity of flow sensors and at least some of said multiplicity of heaters are connected to said individual mechanically controllable sections of the lattice.
 4. The stent of claim 3 wherein said lattice is made of a shape memory material that has an original shape and different temporary shape wherein said shape memory material changes the lattice from said original shape to said different temporary shape upon a change in the temperature of said shape memory material.
 5. The stent of claim 1 wherein said heaters are additive manufactured heaters.
 6. The stent of claim 1 wherein said heaters are micro-electro-mechanical systems heaters.
 7. The stent of claim 1 wherein said flow sensors are additive manufactured flow sensors.
 8. The stent of claim 1 wherein said control system is an additive manufactured control system.
 9. The stent of claim 1 wherein said control system is a microchip.
 10. The stent of claim 1 further comprising model simulations, wherein said multiplicity of flow sensors are flow sensors that sense information and said flow sensors that sense information transmit said information to said control system wherein said control system receives said information, compares said information to said model simulations, analyzes the information, and activates said heaters.
 11. The stent of claim 1 further comprising model simulations, wherein said multiplicity of flow sensors are flow sensors that sense shear stress information and said flow sensors that sense shear stress information transmit said shear stress information to said control system wherein said control system receives said shear stress information, compares said shear stress information to said model simulations, analyzes the shear stress information, and activates said heaters.
 12. The stent of claim 1 further comprising model simulations, a telemetry unit connected to said stent body and operatively connected to said multiplicity of flow sensors, said multiplicity of heaters, and said control system; and and a remotely located receiving unit wherein said flow sensors are flow sensors that sense information and said flow sensors that sense information transmit said information to said control system, wherein said control system collects said information, wherein said control system compares said information to said model simulations and produces compared information, wherein said telemetry unit transmits said compared information, and wherein said remotely located receiving unit receives said compared information.
 13. The stent of claim 12 wherein said remotely located receiving unit and said telemetry unit are a remotely located receiving unit and a telemetry unit that provide periodic reports with said compared information.
 14. The stent of claim 12 wherein said remotely located receiving unit and said telemetry unit are a remotely located receiving unit and a telemetry unit that provide on demand periodic reports with said compared information.
 15. The stent of claim 12 wherein said compared information includes information on stent health and wherein said remotely located receiving unit and said telemetry unit are a remotely located receiving unit and a telemetry unit that provide periodic reports or on demand reports with said compared information on stent health.
 16. The stent of claim 1 wherein said stent lattice is a super lattice.
 17. A stent adapted to be located in a coronary artery, comprising: a cylindrical stent body comprising a stent lattice made of shape memory material adapted to be located in a coronary artery wherein said stent lattice includes mechanical stent surface modification regions, a multiplicity of flow sensors connected to said cylindrical stent body, a multiplicity of heaters connected directly to said shape memory material of said stent lattice in said mechanical stent surface modification regions, and a control system that is part of said cylindrical stent body and is operatively connected to said multiplicity of flow sensors and said multiplicity of heaters that controls said heaters to change said shape memory material and said mechanical stent surface modification regions.
 18. The stent of claim 17 wherein said cylindrical stent lattice made of shape memory material is a cylindrical stent lattice made of shape memory material that has an original shape and different temporary shape and wherein said heaters produce heat that causes said shape memory material to change from said original shape to said different temporary shape.
 19. The stent of claim 17 wherein said multiplicity of flow sensors are flow sensors that provide flow information and wherein said control system is a control system that receives said flow information and activates said heaters.
 20. The stent of claim 17 wherein said heaters are additive manufactured heaters.
 21. The stent of claim 17 wherein said heaters are micro-electro-mechanical systems heaters.
 22. The stent of claim 17 wherein said flow sensors are additive manufactured flow sensors.
 23. The stent of claim 17 wherein said control system is an additive manufactured control system.
 24. The stent of claim 17 wherein said control system is a microchip.
 25. The stent of claim 17 further comprising model simulations, a telemetry unit connected to said cylindrical stent lattice and operatively connected to said multiplicity of flow sensors, said multiplicity of heaters, and said control system; and a remotely located receiving unit wherein said flow sensors are flow sensors that sense information and said flow sensors that sense information transmit said information to said control system, wherein said control system collects said information, wherein said control system compares said information to said model simulations and produces compared information, wherein said telemetry unit transmits said compared information, and wherein said remotely located receiving unit receives said compared information.
 26. The stent of claim 25 wherein said remotely located receiving unit and said telemetry unit are a remotely located receiving unit and a telemetry unit that provide periodic reports with said compared information.
 27. The stent of claim 25 wherein said remotely located receiving unit and said telemetry unit are a remotely located receiving unit and a telemetry unit that provide on demand periodic reports with said compared information.
 28. The stent of claim 25 wherein said information includes information on stent health and wherein said remotely located receiving unit and said telemetry unit are a remotely located receiving unit and a telemetry unit that provide periodic reports or on demand reports with said compared information on stent health.
 29. The stent of claim 17 wherein said stent lattice is a super lattice. 